Low Titer Group O Whole Blood Utilization In Pediatric Trauma Resuscitation: A National Survey
Dana Meshkin1, Mark Yazer1, Nancy Dunbar2, Philip Spinella3, *Christine M Leeper4
1University of Pittsburgh, pittsburgh, PA;2Dartmouth-Hitchcock, Lebanon, NH;3Washington University in St Louis, St Louis, MO;4Children's Hospital of Pittsburgh of UPMC, pittsburgh, PA
Background (issue): Renewed interest in low titer group O whole blood (LTOWB) transfusion has led to increased utilization in adult trauma centers; little is known regarding the practice of LTOWB transfusion in pediatric centers.
Methods: A survey of LTOWB protocols and utilization in United States pediatric level 1 trauma centers.
Findings: Responses were received from 44/72 (61%) centers. These institutions were primarily urban (82%) and pediatric-only (58%). There were 16% (7/44) centers using LTOWB, 7% (3/44) imminently initiating an LTOWB program, 44% (20/44) with positive interest but no current plan to develop a LTOWB program, and 33% (15/44) with no immediate interest in an LTOWB program. The most common barriers to implementation were concerns about inventory management (46%), wastage (46%), infrequent use (40%), cost (29%) and unclear efficacy (20%).Only 2 hospitals have a minimum recipient weight criterion, while 6 have a minimum age criterion; most (7/10) hospitals restrict the maximum volume of LTOWB transfused. Before RhD status becomes known, 40% use RhD negative LTOWB for both males and females, 40% use RhD positive LTOWB for males and RhD negative LTOWB for females, and 20% use RhD positive LTOWB for males and RhD negative RBCs for females. Maximum LTOWB storage duration was 14-35 days (range) and units nearing expiration were used for non-trauma patients (40%), processed to RBC (40%), and/or discarded (40%).
Conclusions (implications for practice): The utilization of LTOWB is increasing in pediatric level 1 trauma centers in the United States; product specifics and protocols are highly variable.
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